Health Reform in Idaho Fact Sheet

As a result of U.S. Supreme Court's decision regarding the Patient Protection and Affordable Care Act of 2010, Idaho policymakers have two major decisions to make:

  • Whether to create a state-run health insurance exchange, or to defer to the federal government to create such an exchange in Idaho;
  • Whether to expand Idaho's Medicaid program to cover most individuals earning less than 133% of the federal poverty level (FPL

Creation of State Run Insurance Exchanges

Health Insurance Exchanges – What are they?

A major component of the PPACA is the creation of so-called “Affordable Insurance Exchanges.”  Beginning in 2014, such Exchanges are intended to operate as an online, on-stop-shop for individuals and small businesses to compare and purchase health insurance plans.  Additionally, such exchanges should also help individuals and businesses determine whether they qualify for tax credits to offset some of the costs of purchasing health insurance. [1] 

Who Creates and Operates the Exchanges?

Under the PPACA, states are given three option to: (1) create an exchange in partnership with the federal government; (2) create and operate an exchange on its own; or (3) defer to an exchange run by the federal government (the default if state policy makers do nothing). [2]   If a state chooses to be involved with the Exchange, the Governor submit a signed letter of intent and “blueprint” for the Exchange to the U.S. Department of Health and Human Services by November 16, 2012.[3]   The state then has until January 1, 2013 to have an exchange “that HHS approves and fully or conditionally operational.”[4]

What are Idaho Policy Makers Doing?

In January 2012, the Governor and the Idaho Legislature’s Health Care Task Force backed a bill (HB 433) to create a state-run Exchange.  In part due to the uncertainty regarding how the Supreme Court would rule on the constitutionality of the PPACA, however, the Legislature failed to enact this bill prior to adjourning in March 2102. [4]  Shortly after the Supreme Court issued its ruling in June, the Governor convened a working group that is investing the issue.  The Idaho Legislature’s Health Care Task Force has also been investigating the issue this summer. [5]

Expansion of Medicaid Program

Under the Supreme Court’s ruling, states have the option to choose whether to expand their Medicaid programs to cover nearly all adults with a household income of earning less than 138% of the federal poverty level (approximately $31,000 a year for a family of 3 in 2012), or to keep the programs as currently operating.  (Under Idaho’s current Medicaid eligibility requirements, a non-pregnant adult in a family of four must have a household income of less than $4,584 to qualify for Medicaid). [6]

From 2014 to 2016, the federal government will pay for 100 percent of cost covering individuals newly eligible under the expanded Medicaid Program.  From 2020 on out, this match will reduce to 90%. [7]

Although the PPACA as written would have required states to expand their Medicaid programs or lose all federal funding for Medicaid, the Supreme Court ruled that such a requirement is unconstitutional.  As such, Idaho lawmakers must choose whether to expand the Medicaid program or not.

What are Idaho Policy Makers Doing?

Governor Otter created a working group to research the optional expansion of Medicaid in Idaho.  This work-group met on August 6, [8] and discussed initial findings that 90,000 to 100,000 additional individuals would be eligible under an expanded Idaho Medicaid program. [9]  The Idaho Legislature’s Health Care Task Force has also addressed the issue this summer.


1 http://www.healthcare.gov/law/features/choices/exchanges/index.html

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